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Looking for new ways to streamline pharmacy operations in the face of the pharmacists' shortage, chain pharmacy operators continue to add automation where they can, not just in stores but in centralized facilities that automate prescription fulfillment or handle adjudication issues.

At least 13 pharmacy chains are involved in central-fill and/or central processing programs or have the capability to do central-fill but haven't gone live yet, according to an industry source. This is in addition to chains that operate a central-fill from a "hub," or master store, that services other stores, a strategy that Duane Reade uses in New York City.

Among the larger, automated central-fill facilities in operation today are five facilities owned by Kaiser Permanente, a health maintenance organization; two operated by wholesaler AmerisourceBergen, one in partnership with Longs Drug Stores and one with supermarket chain Raley's in Sacramento, Calif.; one operated by Discount Drug Mart in Cleveland; two owned by Kroger, one in Portland, Ore., and one m Columbus, Ohio; one operated by H-E-B Grocery in San Antonio; and one operated by McKesson in conjuntion with Giant Eagle in New Castle, junction with Columbus facility set up for central fulfillment, but the facility may not be activated. Kroger uses TechRx software in both facilities.

Terry Burnside, chief operating officer for Longs Drug Stores, said the central fill that Longs operates with AmerisourceBergen filled its 1 millionth prescription in early April and continues to exceed expectations. "It's filled more than 10,000 prescriptions a day on numerous occasions, and its current daily output is roughly equal to that of about 60 pharmacists," he said. Burnside added that the central-fill currently processes about 42,000 prescriptions weekly and he expects that number to increase steadily. The facility services 180 Longs stores in northern California and northern Nevada.

At H-E-B, James Parker, operations manager for the central fill division, said the facility, which opened in April 2000, processes about 9,200 prescriptions a day, servicing 128 of H-E-B's 164 pharmacies. He said its volume has increased 30 percent versus last year. H-E-B, which worked with pharmacy system designer SI/Baker to design the facility, uses McKesson Automated Prescription Systems automated counters for ensing. "Since we're now doing about 20 percent of all the refills for the pharmacies who use the central-fill, and since refills account for about 50 percent of the volume of an average pharmacy, we see a lot of opportunity for future growth," Parker said.

Mike Seidl, director of sales for Vernon Hills, 111.-based AutoMed, whose robotics and work flow systems are used in central fills operated by Longs, Duane Reade and Raley's, said he expects "six or possibly seven" pharmacy chains to either open or expand central-fill facilities over the next 12 months. Raley's, which has had a central-fm facility since May, declined to provide any details, but one informed source said the facility has the capability of filling prescriptions for a proximately 90 stores.

"Just like robots and work-flow systems help store pharmacies improve the balancing of the work load and lower the cost of filling prescriptions," Seidl said, "so do centralized facilities for filling and processing provide similar economic benefits. And it isn't a matter of doing one or the other. Many chains are saying they need to do both, automate dispensing in the stores as well as automate dispensing in centralized locations."

Some chains, Seidl said, will follow the example of Longs and partner with wholesalers such as AmerisourceBergen to open a central-fill. Others, he said, may just elect to let their wholesalers own and manage a central-fill while they pay a fee to use its services.

Mike Jordan, president of Alpharetta, Ga.-based SI/Baker, an automated systen-is integration company that is 50 percent owned by McKesson APS, said he expects at least five more retailers to open central-fills over the coming year. "Chains whose pharmacy sales are growing by 15 percent to 20 percent a year are realizing that central-fills can help take the pressure off over-worked stores," he said. "A store supported by a central-fill can handle 20 percent more prescription volume without having to add to staff."

In some situations, chains are starting to centralize the processing of prescriptions to help take the pressure off individual stores. Central processing is often a prelude to central fulfillment.

Giant Food in Landover, Md., has set up a central processing facility at its corporate headquarters, which handles adjudication for 75 stores. Giant vice p resident of pharmacy operations Russ F air said the facility currently has six computers that tie into the stores through a telenet system.

"Any problems that come up in the stores, the technicians in central processingtake care of it," Fair said

Before Giant set up its central processing system, Fair said, store pharmacists on busy days like Monday would have to start work at 7 a.m. or 8 a.m. to get ready for the pharmacy to open at 9 a.m.

Fair said Giant is considering expanding the program to cover all stores and to extend its operating hours until the early evening.

New PDX facility

PDX, a pharmacy management systems provider, plans to o en a 100,000-square-foot central to open a facility near its office in Fort Worth, Texas, this fall, and is negotiating with many of the 63 pharmacy chains who use its pharmacy management systems to sign up for the central-fill service. Kenny Hill, chief operating officer, said the service, which will be called Rx.com, will operate as a separate division owned by PDX's parent, National Health Information Network. He said it will have the capability, at peak capacity, to service all of the approximately 10,000 stores that use PDX pharmacy management systems.

Hill said PDX acquired the Rx.com name when the original Rx.com, one of the first online drug stores, went out of business over a ear a o. PDX also acquired many of Rx.com s assets, he said. When Rx.com opens, it will have six lines of robotic prescription dispensers that together will have the capability of dispensing 90,000 prescriptions every eight hours, or 15,000 prescriptions per line.

Hill added that PDX retailers per will not only have the option of having scripts dispensed at a central facility and returned to their stores over-night, they will also be able to have the prescriptions home-delivered to customers if they choose.

Pittsburgh-based TechRx is getting ready to roll out its new pharmacy management system/work-flow solution: TRex One Enterprise. Peter May, director of marketing, said T-Rex One Enterprise is the first pharmacy management and workflow solution that enables chains to function as a single entity. May said the system makes it possible for a chain to combine and leverage its chainwide resources by centralizing all of its software and data across all channels including corporate headquarters, retail stores, central-fill, central processing and mail order facilities. May added that T-Rex One Enterprise has been designed to help chains "fill more prescriptions, improve customer service and reduce operating and inventory expenses."

At the store level, there is still dramatic growth in the installation o f systems designed to streamline the workflow process, as well as automate the counting and filling of prescriptions.

Costco, which has pharmacies in all but 10 of its 287 stores, is rolling out Innovation Associates' PharmASSIST Enterprise system. Vic Curtis, assistant vice president of pharmacy, said the system has helped Costco reduce its error rate almost "down to zero."

Costco and IA have been working together on customizing the workflow software and the system for almost three years, Curtis said, Following a three-store pilot that began two and half years ago, Costco this fall begins a rollout chainwide of the system, starting with 35 more stores. The complete rollout will probably take three years, Curtis said.

"We've built a model of the system so we can scale down for low-volume stores, as well as up to high volume stores," Curtis said.

High-volume Costco pharmacies do "well over 600 prescriptions a day on a six-day average," he said. Costco piloted the system in its three highest volume stores, and one store, Curtis said, "went nine months without making an error before the study was ended."

Some of the features that Curtis said were especially helpful were a "Will Call" bin management application that identifies the location of prescriptions when a patient is at the pickup window, a fax to doctor application for getting refill approvals and an electronic signature pad that Curtis said has dramatically improved Costco's service levels.

IA's new version 6 of its PharmASSIST workflow software contains many of the upgrades that Costco is now using, said Jamie Reno, a company spokesman.

Other developments

In related technology developments, AutoMed, which was recently acquired by wholesaler AmerisourceBergen, is extending its line of OptiFill automated robotic dispensers by introducing smaller systems that can start with volumes as low as 3,000 prescriptions per day per shift and scale up to as many as 8,000 prescriptions a day per shift as demand builds.

At the National Association of Chain Drug Stores' Pharmacy & Technology show this month in San Diego, Mission, Kan.-based ScriptPro will debut several new pharmacy technology system peripherals, including an electronic signature pad and a prescription pick-up display board that are both integrated into the ScriptPro system. It also will introduce a smaller size robotic prescription dispensing system, SP100, and a smaller unit of use dispenser, called miniSPUD, for storing pre-packed pharmaceutical items such as inhalers and birth control pills.

McKesson APS will introduce AccuMed powered by AutoLink, its newest generation of automation. A high-speed dispensing technology, AccuMed can dispense up to 10 capsules/tablets per second. The new system, which pharmacists helped design, also has a number of security features, including barcode verification to ensure that the correct prescription goes to the correct patient. It can scan in the identity of the person filling the prescription as an additional safety fea ture and, through AutoLink, it has an application for inventory control.

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